Hi everyone! I just interviewed at an ER in NYC on friday and they unofficially offered me the job! My goal has always been to become an ER nurse and I really want to do it as a new grad. The hospital orientation is 6 months long with a preceptor and 2 weeks of strictly classroom. It is a teaching establishment that is going for magnent status and is in the process of adding onto thier ER.
All of that makes me want to sign up and believe that I can become a great ER nurse. The terrifying thing is that the ratio is 8:1. I believe that they have it split up into critical and non-crital then they have a seperate asthma room, fast track, and ICU transfer....
Am I crazy to consider this? There is something exciting about being apart of the changes and the chaos.... But I don't want to risk my license when I'm just starting! I would think that the residents and attendings would really help out since it is primary nursing. What are some questions that I should ask before accepting the position? Thanks so much.
I know what you mean about the drive by nursing. It's horrible. Teaching? What teaching? You drawn blood, give a few drugs, chart and move on. Hopefully in a couple of hours you can get back to reassess. That I don't mind that as much as the holding of pts in the ED. An ER is supposed to stablize and move on. Get 'em in, get 'em out. But when you have to do FS q1h and CE on 3 tele pts and ER pts, that's when it gets interesting. 4:1 That's so awesome. I need to find that! TamrRN07 is right, 8:1 is about average in NYC. but the ratio changes come holding season (what I call Nov to Feb). Hospital admins think the ER has limitless beds. The floors are full so keep them down in the ER and somehow we have to make room. Then go on divert or bypass because we're too full. Never ceases to amaze me.
I wouldn't do 8:1 on a med-surg floor to say nothing of the ER. We are 2-3:1 on the trauma side and 3-4:1 on the medical side. In season (the winter), when all of the snowbirds come down, you usually have 3 rooms and may have a hall bed for a while while we are trying to clear out the waiting room. The thing that makes me laugh is all of the people who come down from NYC and are bitching at us about having to wait 3-4 hours to be seen. Their battle cry is always "It's never like this up in NY". Well, if there's 120 people in the waiting room, I'm guessing that 3-4 hours would be a really, really short wait. I tell them that they can be on a plane and back in NYC in 3-4 hours if they want to try that route. (PS: It's not just NY, it's also Baltimore, Ohio, PA - anywhere North of the Mason-Dixon line. If it's so damn terrific up there, why are you here???)
I wouldn't do 8:1 on a med-surg floor to say nothing of the ER. We are 2-3:1 on the trauma side and 3-4:1 on the medical side. In season (the winter), when all of the snowbirds come down, you usually have 3 rooms and may have a hall bed for a while while we are trying to clear out the waiting room. The thing that makes me laugh is all of the people who come down from NYC and are bitching at us about having to wait 3-4 hours to be seen. Their battle cry is always "It's never like this up in NY". Well, if there's 120 people in the waiting room, I'm guessing that 3-4 hours would be a really, really short wait. I tell them that they can be on a plane and back in NYC in 3-4 hours if they want to try that route. (PS: It's not just NY, it's also Baltimore, Ohio, PA - anywhere North of the Mason-Dixon line. If it's so damn terrific up there, why are you here???)
Which hospital in Naples do you work at??? I worked in Naples as a traveler in the ER this past winter- I think I might have worked with you!!
We're now there because it's so damn warm! As for the wait...yeah, pt's wait 3 hours just to see an MD, never mind the nurse taking care of them! Especially if the c/c is stupid...it's gonna be a while. I used to work at the Jersey Shore. In the summertime, the New Yorkers would come down (we would call them bennys). Anyway, our evals would go up because they would be seen in an hour vs a few in the city. That's so weird that they complain to you. Sorry
I believe it stands for Bayonne, Edison, Newark, New York. All the "northerners" that come down to the shore from Memorial Day to Labor Day. That's the "Benny" season.
I read the original post, skipped the rest to comment that I would never accept an 8:1 ration in an ER. Every ER patient can turn into a critical patient very suddenly. In fact, I don't even want to be a patient (or any of my family members either, well, maybe my sister-in-law:devil:) in an ER that has this kind of ratio.
Specializes in Emergency Nursing Advanced Practice.
Ridiculous? YES!
[EVIL]Dangerous? YES!![/EVIL]
Uncommon? Increasingly NO.
Where I used to work we were so poorly staffed and so very busy that if a critical patient came in that needed 1:1, the other staff might have 10 or 12:1 ratio and some of them could be pretty sick. And that staffing pattern would persist for several hours as the ER docs wanted to do EVERYTHING in the ER instead of getting patients up to ICU.
In my ER, having 8 patients is a great shift!! It seems dangerous and can be but it works.
Just on the medicine side of the ER alone we can have 2 attending MDs, 2 ER residents (one 2nd yr, one 3rd yr), 1 internal med MD, and 2 interns, and (with good staffing, which almost never happens) 9 RNs to about 100-120 pts. Even though we hardly ever have decent staffing, it works because there is usually always someone looking at your patient, whether it be MDs, interns, med students, another RN, the VERY RARE tech, or xray, CT, EKG tech, phlebotomy, paramedic students... someone is looking at them and can tell if they are still breathing and not in any acute distress.
We are divided into teams and one team (on a good day) will have 2 RNs to about 20-40 patients. I was on the internal medicine MD team one night and had 15 patients in beds.. again, this is NOT an ER doctor... so things move a lil more slowly...
It's pretty rare that I feel like I'm putting my nursing license in jeopardy... so it's tough to advise on this subject being that I don't know what your facility's ER is like... some people wouldn't dare try out our ER but I think it's a great facility and an "organized chaos" as my friend likes to call it... Good luck!
no way would i take a 8;1 ratio in a main ed area .6:1 is the max i have ever had and i have worked ers.no that number of fasttrack pts is different its treat and street .i would never except 8:1 thats ridiculous and dangerous in any circumstances i don't care how well the staff works together.you are putting your license at risk .i have 20 yrs experience no way can a new grad handle that .
I would ask if they are specifically giving the 8 to 1 regarding RNs. I ask because our ER is separated into several different areas of acuity. The highest acuity assignments staff 1 RN for 2 pts (usually end up with 4 total d/t hall pts. ) We also have areas where there can be up to a 9:1 ratio for the RN, but that nurse will also have LPNs and techs assigned to that area as well. For example, one area we have has potential for 11 pts, and is staffed with 2 RNs, an LPN, and a tech. Another is 9 beds for an RN and two LPNs.
So while the RN to pt ratio may sound impossible, if you have support staff with you, it actually works out well. Ask and see if you are truly caring for 8 patients on your own without any other staff- if that's the case, then I 'd say to run from that job.
Specializes in Emergency Nursing Advanced Practice.
no way would i take a 8;1 ratio in a main ed area .6:1 is the max i have ever had and i have worked ers.no that number of fasttrack pts is different its treat and street .i would never except 8:1 thats ridiculous and dangerous in any circumstances i don't care how well the staff works together.you are putting your license at risk .i have 20 yrs experience no way can a new grad handle that .
That is one of the reasons why I left where I had worked for over 24 years. Too unsafe and administration did not care. Now they have temporary docs and agency nurses and so things are even worse. A friend still works there and he has had 20:1 ratios when the agency staff fail to show up and there is nobody to call in.
edprincess
27 Posts
I know what you mean about the drive by nursing. It's horrible. Teaching? What teaching? You drawn blood, give a few drugs, chart and move on. Hopefully in a couple of hours you can get back to reassess. That I don't mind that as much as the holding of pts in the ED. An ER is supposed to stablize and move on. Get 'em in, get 'em out. But when you have to do FS q1h and CE on 3 tele pts and ER pts, that's when it gets interesting. 4:1 That's so awesome. I need to find that! TamrRN07 is right, 8:1 is about average in NYC. but the ratio changes come holding season (what I call Nov to Feb). Hospital admins think the ER has limitless beds. The floors are full so keep them down in the ER and somehow we have to make room. Then go on divert or bypass because we're too full. Never ceases to amaze me.